Histological suture changes following retraction of the maxillary anterior bone segment after corticotomy

Speedy surgical-orthodontic treatment with temporary anchorage devices as an alternative to orthognathic surgery

INTRODUCTION

We describe a new type of corticotomy-assisted orthodontic treatment called speedy orthodontics for treating severe anterior protrusion in adults. Once medullary bone is deformed after corticotomy, recovery to its original dimension is impossible if the greenstick fractured bone is ossified as it was deformed. Speedy orthodontics describes a protocol to allow movement of dental segments over a shorter time by using a corticotomy and an orthopedic force with temporary anchorage devices.

METHODS

After proper diagnosis and treatment planning, the maxillary first premolars are removed, and then a corticotomy is performed to outline a block of bone around the maxillary anterior teeth under local anesthesia. An interval of 2 weeks is optimal between the labial and lingual corticotomy for sufficient healing and less patient anxiety. The maxillary anterior teeth are fixated into a single unit with the specially designed lingual retractor. A retraction force of 500 to 900 g per side is applied to the lingual retractor and the C-palatal plate placed in the midpalatal area. After anterior bone segment retraction, finishing is performed with full fixed appliances.

RESULTS

Correct overbite and overjet, facial balance, and improvement of lip protrusion were obtained in adults with protrusion treated by speedy orthodontics.

CONCLUSIONS

This new type of treatment mechanics can be an effective alternative to orthognathic surgery in adults with protrusion.

Corticotomy and compression osteogenesis in the posterior maxilla for treating severe anterior open bite

A new technique is described for outpatient treatment of anterior open bite. The compression osteogenesis method with a two-stage corticotomy was used in the posterior maxilla to treat a woman with severe anterior open bite. Three-week post-surgical compression using anchor plates and elastics repositioned the posterior maxillary bone/teeth segments by 7 mm to the ideal superior position. The patient had a stable skeletal position of the maxilla at 14-month follow-up with satisfactory results and no complications after orthodontic treatment. This technique appears to be an efficient option for treating patients with anterior open bite.

Orthopedic intrusion of premaxilla with distraction devices before alveolar bone grafting in patients with bilateral cleft lip and palate

Surgical repositioning of the downward displaced premaxilla in bilateral cleft lip and palate patients remains a controversial and perplexing issue because of its detrimental effects on the growth of the premaxilla. The purpose of this prospective clinical study was to introduce and evaluate the treatment results of an innovative technique for nonsurgically intruding the downward displaced premaxilla. Eight consecutive cases of bilateral cleft lip and palate at the age of mixed dentition were included for the correction of their premaxillary deformities. A pair of intraoral tooth-borne distraction devices was used for the orthopedic intrusion. Serial lateral and posteroanterior cephalometric radiographs were taken periodically for evaluating the growth of the premaxilla 1 year before the intrusion, changes during the intrusion, and growth/relapse up to 1 year after the intrusion. There was no overgrowth of the premaxilla or overeruption of the maxillary incisors during the 1-year observing period before the orthopedic intrusion. The treatment results revealed that the downward displaced premaxillae were all corrected within 1 month. Cephalometrically, 46 percent of the correction resulted from a true orthopedic intrusion and another 54 percent from a dentoalveolar effect in which the maxillary incisors were intruded and the premaxillary dentoalveolus was shortened. The cephalometric evaluations also implied that what occurred during the orthopedic intrusion was mostly the sutural contraction osteogenesis/osteolysis in the vomeropremaxillary suture combined with slightly mechanical upward displacement of the vomeronasal septum complex and nasal bones. The orthopedic intrusion of the premaxilla with distraction devices is an effective nonsurgical method for correcting the downward displaced premaxilla before alveolar bone grafting in patients with bilateral cleft lip and palate, and the results remained stable after 1 year.